1. Cerebral Palsy
Dr Venkatesh C
Assistant Professor of Pediatrics

2. Introduction
• Major cause of disability in children
• Incidence 1 in 500 births
• 70-80% are due to prenatal factors
• No known cure, Prevention is the key.

3. Antenatal Brain Growth

4. Postnatal Brain Growth
• Brain growth continues postnatally well into
adolescence
• More than 90% Brain growth is complete by 2
years
• As age advances, myelination increases with
pruning of synapses

5. Definition
• Disorder of movement and posture
• Non-progressive insult
• growing brain
• Dynamic manifestations

6. Aetiology
• Antenatal- Extreme prematurity, Multiple
gestation, IEM, Genetic diseases, Brain
malformation, Congenital infection, maternal
toxemia, placental abnormalities,
coagulopathy, Heamorrhage
• Birth- Low birth weight, MSL, Infection,
trauma, Kernicterus
• Postnatal- infection, trauma, toxins

7. Pathology

8. Pathology

9. Pathology

10. Pathology

11. Types
• Spastic
• Dyskinetic
• Hypotonic/ataxic
• Mixed

12. Spastic CP
• 70-80% of CP
• Increased muscle tone- clasp knife type
• Increased reflexes, clonus, contractures
• Scissoring and toe walking
• Difficulty changing diapers
• Seizures & mental retardation
• Feeding difficulty

13. Types based on limb involvement

14. Hyperkinetic/athetoid
• 10-20% of CP
• Involuntary movements of hands, feet, arms,
muscles of face/tongue
• Movements increased by stress, decreased by
sleep
• Mental retardation

15. Hypotonic/ataxic
• Least common type
• Floppy infant
• Poor coordination
• Unsteady gait
• Difficulty in performing rapid movements

16. Mixed
• Combination of above
• Spastic and athetoid most common
• Hypotonic and athetoid
• Variable frequency of seizures, MR

17. Functional Classification

18. Early markers
• Persistent fisting/ cortical thumb
• Persistent primitive reflexes
• Irritability
• Delayed development
• Early hand preference

19. Asymmetric tonic neck reflex

20. Diagnosis
• Good history and physical examination
• Neuroimaging CT/MRI
• IU infection screen
• Metabolic & genetic testing
• Coagulation studies
• Screening for co-morbidity – vision, hearing,
seizures

21. Treatment
• Multi-disciplinary approach
• Early stimulation
• Monitoring growth, nutrition
• Vision and hearing assessment
• Control of seizures
• Reduce spasticity and contractures
• Promote self care

22. Prognosis
• No head control by age 1- unlikely to walk
• Not sitting by 4 yrs- 99% will not walk
• Sits unsupported by 2 yrs- 100% will walk

23. Prevention
• Proper antenatal care and fetal monitoring
• Hypothermia
• Magnesium sulphate